Current challenges in practice of psychiatry in India.

Abstract

Byline: Vidyadhar. Watve Honorable immediate past President Dr. T.V. Asokan, members of the Executive Committee, all the zonal, state, regional and local branch office bearers of the IPS and above all most revered life fellows, fellows and members of the IPS. On the eve of my presidency, IPS is at its most glorious era. Two of alumni have held or are holding Presidentship of international organizations, an active member is the secretary general of the WPA, four of our members are holding high offices at the WPA and one IPS member has been bestowed with a prestigious international award. First of all I am assuming office when Dr. Asokan with his vision, modesty and skill has led the IPS to a position which makes my task easier for the coming year. I have chosen my topic as current challenges in practice of psychiatry in India because that defines my life of last 38 years as a psychiatrist and as an individual. What better way to describe my expertise and experience than this, which may guide younger colleagues in practice of psychiatry. My Early Days I entered this magnificent branch of medicine as a postgraduate student in 1974 which was the era of Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM II) and International Classification of Diseases 9 (ICD 9). Mental illness was understood and interpreted in terms of psychodynamics of the symptoms. My interest in psychodynamic theory did not help me to convert it into any therapeutic success. However, it helped me to nurture my interest in theatre. As a physician then attached to Film and Television Institute of India at Pune, I had an opportunity to associate and interact with many theater and film personalities such as Girish Karnad, Dr. Jabbar Patel, Naseeruddin Shah, Satish Alekar and Dr. Mohan Agashe. This association helped me immensely in my practice. I acquired better communication skills and learned to apply it effectively to psychoeducate patients and caregivers. The enhanced communication skills helped me not only in my doctor-patient relationship but also to communicate effectively with fellow professionals. However, that was not a substitute for a search for better understanding and improved treatment skills. My seniors and colleagues would often come up with innovative ideas, which contributed to improved patient care. New Challenges The field of psychiatry has since witnessed major strides. We now have adequate data to claim that mental illness is a disease of the brain. Neuroimaging and success of pharmacology raised hopes of a significant breakthrough which is yet to become a reality. Today, we face multiple challenges and criticism from within (and outside the field of medicine in general and psychiatry, in particular) that threaten the practice of psychiatry. The new mental health legislation is awaiting Parliament's approval. My predecessors have made relentless efforts to get the voice of IPS reaches the lawmakers. Insurance companies do not acknowledge the needs of the mentally ill. The trend is changing but yet a lot more needs to be done. Closer to our clinical needs, DSM V is published. It was launched by our own alumni Dr. Dilip Jeste. Mastering the new classification will require much learning and re-orientation. ICD 11 is likely to be published in 2017. That will need some more new learning for all of us. Criticism against professionalism and alleged moral corruption by doctors is now being published in the world media and scientific literature. At a global level, the graph curves for cure, life expectancy and quality of life for patients of many serious and potentially life-threatening illnesses have shown major trend for the better. However the prevalence, morbidity and quality of life curves for mental illness have not shown any such bend for the better. Suicide rates, disability rates and eventual improvement rates of mental illness have not shown any significant improvement in the past three decades. …